The United States, like the rest of the world, is facing a fertility crisis. In 2024, the nation’s total fertility rate reached an all-time low of 1.6 children per woman, significantly below the replacement level of 2.1 needed to sustain the population. This decline poses not just demographic challenges, but also economic ones—threatening programs like Social Security as the worker-to-retiree ratio shrinks.
With such urgency, we must broaden our toolkit—not narrow it. I believe that this means fully supporting both Restorative Reproductive Medicine (RRM) and In Vitro Fertilization (IVF), recognizing that they can be complementary, not competing, approaches.
RRM targets the underlying causes of infertility—hormonal imbalances, reproductive conditions like endometriosis, or ovulation irregularities—through individualized treatment plans that may include medication, surgery, and lifestyle optimization. It appeals to people seeking a more natural or holistic path toward fertility and can, in some cases, reduce emotional and financial strain.
IVF, in contrast, enables conception when the body cannot achieve it naturally. It has decades of proven success, especially for older patients or those with complex reproductive challenges. But IVF is often financially prohibitive. A single cycle can cost anywhere from $14,000 to $20,000, and even more depending on medications, procedures, or donor involvement. Real-world costs—including multiple cycles—often exceed $50,000.
Due to its high cost and technical nature, IVF isn’t accessible or desirable for everyone. Some may feel it conflicts with their values, others may not afford it, and still others might prefer to explore less invasive options first.
This is not an “either–or” scenario. RRM and IVF can—and should—be used together to better serve patients:
- RRM can identify treatable conditions and improve reproductive health, possibly increasing chances of success with less intensive interventions.
- For those who progress to IVF, RRM may optimize outcomes by preparing the body, improving overall health, and potentially reducing the number of cycles needed.
Fundamentally, they are tools in the same toolbox, empowering patients with options tailored to their values, needs, and situations.
To truly address this crisis, I believe federal policy should:
- Invest in RRM research and insurance coverage, making regenerative, root-cause fertility care accessible, affordable, and evidence-based.
the - Expand IVF funding, insurance coverage, and support, ensuring cost is not a barrier to the pursuit of parenthood.
- Promote integrated care models, where individuals can start with diagnostic and restorative approaches but transition seamlessly to IVF when necessary—without judgment, delay, or financial hardship.
Families deserve more than one path—or a debate over which is best. They deserve the freedom to chart a path that aligns with their identities, financial goals, and health objectives. RRM and IVF are both essential components of a responsive, inclusive fertility care system that honors every individual’s journey.
We are in a fertility crisis—and the answer isn’t to choose one approach over the other. It’s to support both and to ensure they can work together for everyone.
Dr Marina OBGYN